I believe I have been Infected

[Dunkel13]

Hey Doc,

I really need your help.  On the night of the 31st of January I had oral/vaginal intercourse with a CSW who said she was from Nigeria.  I wore a condom.  I remember watching her rip it open with her teeth and hands, but when the condom was on it felt fine.  I was heavily drunk by this point.  She gave oral and then approximately 7-10 minutes of intercourse.  I have had genital warts in the past.  I had had a wart removed a few weeks prior to this incident.  I remember being very concerned about the condom slipping past this point.  It's about a half inch from the base of my shaft.  And at some point I remember looking down and seeing the condom had moved a little.  So I moved it back as much as I could.

The next morning I felt immorally terrible.  When I went to take a shower I noticed a small/tiny cut or rip near the area I was concerned about for the genital warts.  I immediately started to panic and lose control of my emotions.  I just thought the worst.  After this I continuously monitored my penis.

  On the 8th of Feb up until today my symptoms have been: body shakes, cold chills, hot flashes, tingly sensation in my hands which has transitioned to burning sensation on my hands and forearms, dry cotton mouth, oral thrush, night sweats, not sleeping much if at all, loss of appetite, can't really eat much food because I get nauseated by it (only time I experience nausea) and a dry unproductive cough.  I saw the doctor on the 11th and gave 4-5 blood samples with a urine sample.  He didn't shed any light or any advice/knowledge on anything.  I'm worried, I'm panicked, and I'm an emotional train wreck.I want to know if my fears are justified?  I want to know if I've really got something to worry about here?  What is the likelihood of her vaginal fluids getting onto that spot and infecting me?  Could all of this be caused by stress?  I have tried to convince myself this has all just been stress induced...  

[Edward W Hook, MD]

Clearly your guilt and anxiety over this exposure has not yet resolved.  If your symptoms were due to HIV-2, your subsequent antibody tests would have been positive.  Get a grip on yourself.

There will be no further replies.  EWH

[Dunkel13]

I really do hate to do this but I need clarification on a couple of things.  I was thrilled with the 4th generation results until about a week after, I was still experiencing abdominal pain accompanied with loud abdominal noises, and my stools were still loose.  In addition, my lymph nodes were still enlarged, in fact they have gotten larger in my armpit, my neck near the cervical chain, and the one's in my groin are really hard like a bb pellot and fairly large.  This makes me think I jumped the gun.

I read you say that if a person is concerned for HIV-2 they should wait for a definitive test at 8 weeks.  The person I had the incident with is from West Africa.  I am very confident i do not have HIV-1 thanks to that test, but now I am strongly doubting I can exclude ALL HIV.  I have taken two 3rd Generation tests (11 days/26 days post) and two 4th Generation tests (17 days/31 days post) and at 41 days I took a 2nd Generation INSTI HIV-1/2 Antibody test.  All have come back Negative.  But I'm still concerned HIV-2 cannot be discarded, yet.  In fact I have managed to convince myself I got it.  I am already going to go back to the clinic for either a 7th week or 8th week test to make it definitive.  But, do you think that is necessary of me?  And one last question: Since I believed I showed Acute HIV infection after 1 week, and if it truly was Acute Infection, would my tests from 17 days onward shown positive?  Thanks and sorry.  I suck at this.

[Edward W Hook, MD]

Thanks for the follow-up.  Glad I could help. EWH

[Dunkel13]

I just wanted to say thank you, Dr. Hook!  I tested negative today.  31 days post 4th Generation test.  Also, I would like to apologize for my obsessive and manic behavior.  I certainly learned a hard lesson in life.  And I'm keen on never making it again.  Thanks again!

[Dunkel13]

Fair enough, Doc.  Thanks for your patience with me.  I've been a real mess.  I really appreciate you taking the time to answer my questions!

[Edward W Hook, MD]

It sounds as though you have taken important steps forward, seeking help -congratulations.  Your current questions however are a combination of "what if" questions relating to circumstances that you do not know happened and which suggest that you are struggling with unchecked guilt and anxiety.   You may or may not also be continuing to increase your anxieties with internet searches.  

For instance, could ARS symptoms have gone away by this time- sure they could but your combination of a negative 4th generation test at 17 days as well as the details or your exposure make it astronomically unlikely that your symptoms were due to HIV as opposed to some other, far, far more common community acquired, non-STI viral diseases.  Your question about lymph nodes is similarly misplaced.  It is quite normal for lymph nodes to be palpable and when they are, while a tiny proportion represent HIV infection, they are typically non-specific and due to something else.  

I will not take part in further fueling of your anxieties by addressing these sorts of what if questions.  

You may post your results when they are available. EWH

[Dunkel13]

Doc, I would like one last follow up.  

The symptoms I originally reported to you have gone away.  I was incorrect in telling you I had thrush, as I did not.  I am still experiencing severe anxiety over the issue.  I am married.  I told my wife about everything.  She's basically leaving me.  I saw a psychologist, and even was additionally seen by a physicians assistant to assess me further.  Yet, even though with all this anxiety and emotion my symptoms have gone away.  I am still getting cold chills, and my skin feels weird from time to time, but the symptoms were nothing like what they were originally.  I can feel my lymph nodes.  Mainly in my groin and neck.  I have felt one lymph node (haven't been able to find it again) in my armpit.  I did not take my temperature for the first couple of days when all of my symptoms came on early, so I do not know if I had a fever or not.  

My questions are: 1) Is it plausible I experienced ARS symptoms, or could the fact that I spoke to my wife, saw professional help, and had 3 additional experts look at me to diagnose me help reduce my physical symptoms of stress?

I have read many conflicting articles on cuts or tears on the penis.  I have even read further comments from you to other people on the matter.  So I do not want to doubt what you have already told me.  But it is still a concern for me because the condom did not break.  2) If the break or tear happened during oral/vaginal intercourse meaning it was freshly torn, is your stance still that it was of no concern especially if the condom did not cover it during intercourse?

Lastly, should I be concerned I can feel my lymph nodes in my neck and groin?

[Edward W Hook, MD]

At 17 days a 4th generaion test would detect over 2/3 or recent infections. thus your results, while quite positive and good news, are not yet defintive. EWH

[Dunkel13]

I got tested on the 11th those results still haven't come back yet, and I have no idea how they were tested.  I was tested again on the 17th in England.  My results came back negative.  I know that is too early for an accurate/reliable conclusion.  I'm also unaware of how their test stacks against the U.S. equivalent test.  The Doctor told me it was a 4th Generation test, and I received my results about 4 hours after they took my samples.

1) Can I feel good about testing negative after only 17 days?  Or was that test worthless because it was too early?

Going back after 6th week.  Thanks, Doc.

[Edward W Hook, MD]

Your anxiety is getting the best of you.  Superficial abrasions (or "cuts") o fthe sort you describ eheal almost immediately and donot provide access to the blood stream in a fashion to casue HIV.  

You asked my assessment, you have it.  Feel free to post your test results which, I am confident will be negative.  I will not have more to say. Take care.EWH

[Dunkel13]

Doc,

This is the last time I bother you (I swear).  I just want to get a few things straight.  You said: "in cases where persons at risk for HIV with flu-like illnesses have been evaluated, over 99% do NOT have HIV."  That percentage seems astronomical, judging from how many people are infected each year?  I still have yet to experience a fever, sore throat, or a rash on my chest.  This has given me much needed hope.

And in regard to the small cut I previously had.  The way I know HIV to work is through entering your blood stream.  I'm curious why that wouldn't be a concern in my case?  I have even done "scientific research" of my own to re-enact the using of a condom over my region (using a condom and ole' faithful hand).  It seems to cover it fairly well, but I do remember it moving around once.  And so that's stemmed a lot of my fears.  Had I never seen that cut the morning after, I probably would have never went into this panic frenzy.

Needless to say, I am still very concerned.  And the agony of waiting on my results is painful.  I am however, seeing a great deal of my symptoms being closely related to stress/anxiety.  Or at least that's what I'm wanting to think.  It's very promising and uplifting to think there might just be something else creating my crazy.  But it is also still very scary, because I don't know what you know regarding the matter on how it all works.  So I'm taking it all day by day right now, living in great fear, but also great hope.

Thank you, from the bottom of my heart, Doc!  You've been a very refreshing and uplifting source to turn to in this desperate time of need!  

[Edward W Hook, MD]

There are no data to suggest that it takes healthy persons longer to develop HIV antibodies than others.  

The question of accurate results is not a matter of when you get yur results back but when the test is taken. Currently available combined HIV p24 antigen/HIV antibody tests are definitive at 4 weeks (28 days) after exposure.  EWH

[Dunkel13]

Thank you Dr. Hook!  Your words are very encouraging to read indeed!  How about how healthy a person is in general?  What I mean is, if someone is very healthy, but contracted HIV, would the virus take longer to infect that person?  

Lastly, I get my results back on the 25th of February.  Do you think that's enough time to get a decent/accurate reading?  Thanks again Dr.  Hook!  I'll try not to worry so much.

[Edward W Hook, MD]

Welcome to our Forum.  I'll be please to comment.  I have read through the 11 other comments you have made in the past 24 hours and agree with the comments that have been made earlier.  You wore a condom for the encounter you describe and condom protected sex is safe sex, even when the condom slipped down partially on the shaft of your penis, exposing the site of your prior wart removal.  Condom slippage of the sort you describe occurs regularly yet does not seem to keep the condom from working.  

Your flu-like illness has some of the characteristics seen in some patients with recently acquired HIV however in cases where persons at risk for HIV with flu-like illnesses have been evaluated, over 99% do NOT have HIV. this is likely to be the case for you.  In addition, while rarely the ARS can begin within a week of exposure, more typically it takes a bit longer.  Anxiety can also amplify  symptoms such as those you are experiencing.  Of course however, the only way to know if this is HIV is with testing.  I presume that the tests that your doctor did will be negative.  Please let us know the outcome of your tests., EWH

[Dunkel13]

I forgot to mention I get cold chills, and hot flashes.  And I don't fatigue easy, but I sweat and get more out of breath than I do for normal activities.  I can't think straight.  This has been the only thing I've thought about since the 31st of January.